Bill Sample / December 8, 2018 / Lessie Larson
You want to imagine a symbiotic relationship with your providers and then list the reasons this relationship works and put those actions in your contract as responsibilities of yourself or the provider. You need a list of everything that you have ever heard of going wrong in a medical billing business between the provider and the biller. You need to decide how you would avoid those situations if possible and cover how it would best be handled in your contract if unavoidable. What you are charging your provider and how you will get paid is a fairly important part of your contract. Are you charging a percentage a flat rate or a per claim fee? Is it clearly defined how you are charging? Is the percentage on what is billed out or what is received? Are patient payments included? If charging per claim what constitutes a claim? Is it a line on a claim form or is it per page? You also need to take into account what will happen when the relationship ends.
Patient Liability Percent of Patient Liability is the ratio of patient responsibility to total billed charges and it roughly reflects patient deductibles. This measure is important in measuring front office function as it has little to do with clean claim submission or effective followup. Percent of Accounts Receivable Beyond 60 90 and 120 Days (PARB60 PARB90 and PARB120) PARBX resolves the sensitivity issue of DAR metric and offers simple and charge-invariant metric of billing process. Its graphic representation has a skewed bell shape. Its steepness represents billing process quality: a steep curve and thin tail means healthy billing process while a flat bell and a fat tail means billing problems. According to the MGMA survey 25.35 percent of the average family practices accounts receivables were more than 120 days old in 1997.
But we basically searched until we found a sample very simple contract and modified it for our use. For several years we told ourselves that it was fine and if it wasnt working out for the provider then it wasnt working for us either and we should move on and find new clients. It took us a long time to realize that in several situations our simple contract was actually the reason things were not working out. When you first start your medical billing business you have no idea of the things that can go wrong in a relationship with your clients so you do not know what needs to be included in a contract. Our first contract did not even specify the responsibilities of either the provider or ourselves. It is amazing we were able to find providers willing to sign our contract.